MEDICARE: HEIDI ABBEY LCSW-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	072566	NY
2	1041C0700X	Clinical Social Worker	076421	NY

General Provider Information

NPI Number	:	1306924675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI ABBEY LCSW-R

Provider Business Mailing Address
First Line	:	531 WASHINGTON ST
Second Line	:	SUITE 2401
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4084
Country	:	US
Telephone Number	:	315-788-3332
Fax Number	:	315-788-4584

Provider Business Practice Location Address
First Line	:	531 WASHINGTON ST
Second Line	:	SUITE 2401
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4084
Country	:	US
Telephone Number	:	315-788-3332
Fax Number	:	315-788-4584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	11/04/2010

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